"Medicare Advantage Plans Are The Way Of The Future," Says Maryland Health Official

Main Category: Medicare / Medicaid / SCHIP
Article Date: 16 Nov 2007 - 3:00 PST

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"Medicare Advantage plans are the way of the future," says Dorothy Schulz, manager of a Medicare Advantage health insurance plan offered nationally to residents in Erickson Retirement Communities. Today there are more than 600 Medicare Advantage plans-more than double the number available in 2004.

"Beneficiaries have more choices for their health coverage than ever before," she adds.

Also known as "Part C" of Medicare, Medicare Advantage plans provide Part A (hospital) and Part B (medical) coverage. A Medicare Advantage plan is formed when health insurance companies contract with Medicare to provide health benefits to Medicare beneficiaries, with the idea that private companies can better manage people's care.

According to the government handbook, Medicare and You 2007, the premiums, co-pays, and deductibles can be lower for a Medicare Advantage plan than in Original Medicare (health coverage provided by the government for those 65-plus) or with a Medigap policy. Medicare Advantage plans usually offer extra benefits, and many include prescription drug coverage at a lower cost. "Not all, but most offer transportation too," Schulz adds.

Reasons for the trend:

In many ways, these plans provide advantages for beneficiaries-hence, the name Medicare Advantage. According to the BlueCross BlueShield Association, Medicare Advantage plans encourage prevention and care coordination services; reduce financial barriers to care; and foster quality of care and satisfaction among members.

Medicare Advantage plans place a strong emphasis on preventive health care services or services that aim to prevent illness, keep people healthy, and emphasize early detection of diseases. "They want you to stay healthy and independent, so they provide coverage for preventive services," Schulz says.

Additionally, Medicare Advantage plans often provide care coordination or the organization of health care services between different providers. Care coordination can help manage your overall care, as well as save you money, states Medicare and You 2007.

Many Medicare Advantage plans designate a primary care provider to be responsible for your care coordination efforts. A single point of contact can help eliminate duplicate services-like tests and prescriptions.

Specifically, the BlueCross BlueShield Association reports that Medicare Advantage plans can better emphasize care coordination for those who can benefit from it most-people with chronic (ongoing) conditions like asthma or diabetes.

"Because of the tremendous importance of early intervention in treating chronic illnesses, Medicare Advantage plans' focus on prevention and care coordination and management provides beneficiaries with additional tools to help them manage their health more effectively and avoid preventable complications," concluded the BlueCross BlueShield Association's report.

Research results are in:

The research on Medicare Advantage plans has shown promising results. The Kaiser Family Foundation conducted an analysis of Medicare's 2005 Beneficiary Survey and found Medicare Advantage enrollees are generally in better health than beneficiaries in traditional Medicare. This suggests Medicare Advantage plans may be attracting healthier beneficiaries, according to Schulz.

One of the national Medicare Advantage plans increased the number of preventive screening tests for colorectal cancer by over 9% from 2003 to 2005. Another Medicare Advantage plan reduced inpatient admissions for heart failure patients and emergency room visits by about 20%.

While the health outcomes appear positive, so does member satisfaction. All of the respondents in a phone survey of members in Erickson's Medicare Advantage plan said they were satisfied, very satisfied, or extremely satisfied with their plan. Another survey found what members value most are the low costs and free transportation.

Another survey of people with a Medicare Advantage plan found four out of five people are happy with their health care coverage, and 75% would recommend a Medicare Advantage plan to their friends or family members. A separate survey of people with Medicare Advantage plans found 99% would recommend them to other people.

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